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General NPI Number Information
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NPI Number | 1568728046
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Entity Type | Organization
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Legal Business Name | G.S. MICELI, DPM, S.C.
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 6754 LINDERMANN AVE
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City | MOUNT PLEASANT
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State | WI
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Zip | 53406-5603
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Country | US
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Telephone | 262-654-5555
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Fax | 262-654-9333
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Provider Business Mailing Address
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Address Line | 7201 GREENBAY ROAD SUITE A
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City | KENOSHA
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State | WI
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Zip | 53142-3532
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GIUSEPPI MICELI
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Credential | DPM
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Telephone | 262-654-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 524
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License Number State | WI
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